David Klee, MD: Munson International Medicine Project

Munson Family Medicine Residency, a MSU affiliate, is embarking on a unique project with PCEA Hospital in Chogoria, Kenya. Chogoria is a rural town in central Kenya with a population of about 28,000 people. Chogoria Hospital is a 322-bed facility where Kenyan physician interns and (by 2014) Kenyan Family Medicine residents will train. The hospital is chronically understaffed, which limits the amount of supervision that in-training physicians are able to receive.

The International Medicine Project is a collaborative endeavor between Munson Medical Center (MMC) and PCEA Hospital that will bring together physician teams from each respective institution. We will strive to expand the relationship Munson Medical Center and MSU College of Osteopathic Medicine already have with PCEA Hospital. Dr. Franklin Ikunda, Kenyan family physician, is our program coordinator in Chogoria. He is working closely with our team to facilitate development and implementation of custom-made, standardized physician order sets and clinical pathways for the PCEA Hospital. Standardized medical protocols have been proven in Western hospitals to help improve patient outcomes including decreasing: overall composite death rate, length of hospital stay and hospital complication rates. Native and visiting physicians who have practiced in Chogoria have identified the unequivocal need for establishment of standardized physician order sets at PCEA. In an understaffed hospital with limited medical oversight, such protocols could have dramatic benefits for both physician training and patient outcomes.

Our residency has the responsibility of training new physicians for practice in an ever-changing medical atmosphere. For physicians to be capable of providing high quality medical care for their patients, they must be adept in both medicine and critical thinking. We have an obligation to our residents to provide educational experiences for them to develop both their clinical aptitude and critical thinking skills. In Chogoria, our residents will be challenged daily to hone both their technical skills and improve their ability to problem-solve in a resource limited environment. Their culturally enriched experiences in: public health, chronic disease management, and collaborative research will be invaluable.

In February of 2013, our first team of physicians (Emily Vogt, Abbigale Wilson and David Klee) will arrive in Chogoria. Each team is composed of two senior family medicine residents and one of our core faculty members. Our first team’s goal will be two-fold. First, they will provide direct patient care along-side their Kenyan colleagues. The will also begin development of the Chogorian standardized physician order sets, concentrating on hospitalized pediatric patients. Our second team of physicians (Carolyn DeHann, Nick Orow and Roger Gerstle) will travel to Chogoria in July 2013. Besides providing direct patient care, they will implement and model the use of these order sets. Our teams will gather baseline and prospective data on hospital quality indicators to track the impact of introduction of these clinical protocols and order sets on the quality of care provided.

While in Chorogia, the Munson physicians will present formal teaching topics to the Kenyan medical interns and residents. The Kenyan physicians will also be trained on the development and use of the aforementioned standardized physician order sets. Select Chogorian providers will travel to Michigan for advanced training in protocol development. These super-users will be instrumental in future expansion of protocols in a train-the-trainer method. Since PCEA is a training hospital that places providers throughout Kenya, implementation of physician order sets could have a widespread impact.

Through our enduring affiliation with Chogoria, our residents and their Kenyan colleagues will be able to engage jointly in clinical research and in the development of community public health projects.

“I alone cannot change the world, but I can cast a stone across the waters to create many ripples”

-Mother Teresa